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(MS Clinical Report) Ianne Tuazon

OSTEOMYELITIS
A. Etiology and Pathophysiology
Osteomyelitis is a severe infection of the bone, bone marrow, and surrounding soft tissue. Although Staphylococcus
aureus is a common cause of infection, a variety of microorganisms may cause osteomyelitis.
Category:
a. Exogenous or Direct entry
-Infectious microorganisms enter from outside the
body as in an open wound (e.g. penetrating wounds,
fractures)
- can also occur in the presence of an implant or an
orthopedic prosthetic device (e.g plate, total joint
prosthesis)
b. Endogenous or Indirect entry (hematogenous)
- Most common type osteomyelitis
- patient with vascular insufficiency disorders (e.g.,
diabetes mellitus) and genitourinary and respiratory
tract infections are at higher risk
- The pelvis, tibia, and vertebrae, which are vascularrich sites of bone= most common sites of infection.

Patho:

B. T
ypes,
Clini
cal
Man
ifest
ation
s
and
Com
plica
tions
1. Acute osteomyelitis refers to the initial infection or an
infection of less than 1 month in duration. The clinical manifestations of acute osteomyelitis are both local
and systemic.
Local manifestations:
constant bone pain
swelling
tenderness
warmth at the infection site
restricted movement of the affected part.
Systemic manifestations
Fever

(MS Clinical Report) Ianne Tuazon


night sweats
chills,
restlessness
nausea
malaise
drainage from cutaneous sinus tracts or the fracture site. later sign

**Older adults may not have an extreme temperature elevation because of lower core body temperature and
compromised immune system that occur with normal aging.
2. Chronic osteomyelitis longer than 1 month or an infection that has failed to respond to the initial course of
antibiotic therapy.

Ulceration of the skin


Sinus tract formation
Localized pain
Drainage from the affected area

Long-term and mostly rare complications of osteomyelitis:


o
o
o

septicemia
septic arthritis
pathologic fractures

o
o

amyloidosis
Flexion contracture of the lower
extremity

C. Diagnostic Procedures
a. Bone or soft tissue biopsy- definitive way to determine the causative microorganism.
b. Radionuclide bone scans (gallium and indium) are helpful in diagnosis and are usually positive in the area
of infection.
c. CBC and wound culture with elevated WBC count and erythrocyte sedimentation rate (ESR).
d. X-ray signs usually do not appear until 10 days to weeks after the initial clinical symptoms
e. Magnetic resonance imaging (MRI) and computed tomography (CT) scans may be used to help identify
the extent of the infection.
D. Drug-related Therapy
a. IV antibiotic therapy is the treatment of choice; Vigorous and prolonged(to be effective)
**Teach family members or other caregivers in the home setting how to administer antimicrobials if they
are continued after hospital discharge or are used only at home.
b. For adults, therapy with a fluoroquinolone (ciprofloxacin [Cipro]) for 6 to 8 weeks may be prescribed instead
of IV antibiotics.
c. Oral antibiotic therapy may also be given after acute IV therapy
d. Nonsteroidal anti-inflammatory drugs (NSAIDs), opioid analgesics, and muscle relaxants may be prescribed
to provide patient comfort.
e. Hyperbaric oxygen (HBO) therapy- the affected area is exposed to a high concentration of oxygen that
diffuses into the tissues to promote healing.
f. Negative-pressure wound therapy (vacuum-assisted wound closure)- for wound

E. Surgical Management

(MS Clinical Report) Ianne Tuazon


Sequestrectomy to dbride the necrotic bone and allow revascularization of tissue. The excision of dead and
infected bone often results in a sizable cavity, or bone defect (use of bone grafts to repair)
Reconstruction with microvascular bone transfers if infected bone is extensively resected. Used for larger
skeletal defects. The most common donor sites are the patients fibula and iliac crest.
If the bony defect is small, a muscle flap may be the only surgery required. It provides wound coverage and
enhances blood flow to promote healing
F. Nursing Interventions
1. Focus care on controlling infection, protecting the bone from injury, and providing support.
2. Encourage the patient to verbalize his concerns about his disorder.
3. Encourage the patient to perform as much self-care as his conditions allows.
4. Help the patient identify care techniques and activities that promote rest and relaxation and encourage him to
perform them.
5. Use strict aseptic technique when changing dressings and irrigating wounds.
6. Provide a well-balanced diet to promote healing.
7. Support the affected limb with firm pillows.
8. Provide thorough skin care.
9. Provide complete cast care.
10. Administer prescribed analgesics for pain.
11. Assess vital signs, observe wound appearance, and note any mew pain which may indicate secondary
infection.
12. Watch for signs of pressure ulcer formation.
13. Look for sudden malpositioning of the affected limb, which may indicate fracture.
14. Explain all the test and treatment procedures